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Expression of interest form - Community Engagement Program

Thank you for your interest in applying for a Dementia Australia Community Engagement Program grant, we look forward to reading your dementia-friendly communities project proposal.

Please ensure you have read and understood the Application Guidelines available on the Community Engagement Program webpage or by emailing the Dementia-Friendly Communities team at dementia.friendly@dementia.org.au

Due to the large number of applications received each year, incomplete applications will not be considered.
1.Organisation/ Group name(Required.)
2.Contact person (first and last name)(Required.)
3.Contact person email(Required.)
4.Contact person phone number(Required.)
5.Postal address(Required.)
6.State/Territory(Required.)
7.Organisation/group overview(Required.)
8.Is your organisation/group incorporated?(Required.)
9.If no, please provide name and contact person's details of auspicing agency?
10.Organisation's/Group's ABN(Required.)
11.Is the organisation/group registered for GST (Goods and Services tax)? Please
refer to the Guide to determine GST status.(Required.)
12.Which of the following diverse priority groups will your project reach?(Required.)
13.Please provide an overview of your proposed dementia-friendly communities project.(Required.)
14.Explain how your project meets the aims of the Community Engagement Program?(Required.)
15.Explain how your project will address the dementia-friendly communities key principles 1 to 4?(Required.)
16.How will your project meaningfully include people living with dementia and their carers in the project design and delivery?(Required.)
17.What partnerships will be formed to deliver the project? Please note any formal or informal collaborations.(Required.)
18.If there is any other relevant information about this dementia-friendly communities project, please share it here?
19.What level of funding are you seeking?(Required.)
Current Progress,
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